Risk assessment for metastatic testis cancer
Metastatic germ cell tumors represent a model for curable malignancy, with 70% to 80% of patients cured of their disease. Patients with a good prognosis are likely to be cured, and the aim of investigation is to maintain the high cure rate while minimizing toxicity. For patients who fail to achieve a complete response (CR) to therapy, or who relapse after achieving CR, the prognosis is poor--these patients have become the focus of more intensive treatment to increase the cure rate. Distinguishing which patients will require more aggressive therapy ab initio has been the goal of successive attempts to stratify patients into either good- or poor-risk groups to tailor treatment accordingly. A number of analyses have yielded variable factors and differing schemas to classify patients, culminating in the International Germ Cell Consensus Group whose findings have been utilized to develop the new testicular cancer staging system for the American Joint Committee on Cancer (AJCC) and the Union International contre le Cancre (UICC). This article traces the developments in risk assessment that have lead to this consensus, which would prospectively allow comparison among future clinical trials.